Propofol Infusion and the Potential Use of Propofol Patient-Controlled Sedation (PCS) in Terminally 111 Patients

Abstract

Sedation in end-of-life care is an accepted, but nonetheless controversial, means of providing relief from otherwise refractory and intolerable symptoms and distress. For purposes of this article, the terms 'palliative sedation' and 'patient-controlled palliative sedation' (PCS) will be used to describe clinician-controlled or patient-controlled drug delivery. Ideally, therapy should improve symptoms without unfavorably affecting the patient's level of perception or capacity to communicate with friends and family members. Benzodiazepines, opioids, and certain neuroleptics have been used for palliative sedation with variable success and satisfaction rates. Propofol is a sedative-anesthetic with unique pharmacological properties which may prove highly desirable for use in selected terminally ill patients. There are few case reports and studies about using propofol as a continuous infusion for palliative sedation. Propofol-PCS has been used for sedation in certain surgical procedures in both young and elderly patients; however, its use in terminally ill patients has not been described. The authors postulate that propofol PCS may offer potential benefits for use in various situations at certain stages during terminal sedation.